E/M iPhone App Review: Make Your Money Back In A Day!

I was recently given the opportunity to download a free copy of an E&M bedside coding application for the iPhone from the docs at emcodingapp.com. I told them when I downloaded the application I would spend time using it on my daily rounds and give an honest review of my opinion. I've now been using it for several weeks. I run an unfiltered ship here at the Happy Hospitalist. I'm going to tell it like it is. I warned the creators of this app they weren't guaranteed fairy tales and sugar plumbs on my review. Here's what they said:

Regarding your review of our app, we expect nothing more than your honest opinion. We believe in what we have made and would love yours and others input on how it works for you and if there are ways to improve it. Not sure if you have played around with the other billing apps out there but we believe ours is a major step forward in design, ease of use and content.

I would consider myself to be a self taught clinical coding expert that understands the ins and outs of coding for hospitalist medicine. I came into my review from a position of strength. I understand the work flow required to code correctly. While not perfect, the application has the ability to greatly enhance the efficiency and understanding of E&M coding at the bedside. As you know, the payment difference between a level two and a level three hospital visit is about $20. The application, at just under $20, pays for itself with one patient encounter that is appropriately submitted at a level three hospital follow up instead of a level two or a level two instead of a level one.

I have a bunch of free coding lectures I have previously archived on my blog. I have an expert opinion on what these guys have done. They have left out nuances I think only experts would pick up on, but that's all right. I think they did that on purpose. Applying every possible rule required under E&M coding would make the application unbearable to use. I think they have intentionally gone for the gold by

Making it quick

Making it easy and

Making it focused

This application only covers the nitty gritty of hospitalist based codes. It only walks you through the three hospital follow up codes (99231-99233) and the three hospital admission codes (99221-99223). That's it. It does not take you through any other E/M rules. There is no help with consult codes , prolonged service codes, critical care codes, observation codes, outpatient codes, clinic codes. It covers just the six codes listed above.

If you are a novice and have no idea what you are doing at the bedside with billing and coding, this application will save you. If your salary is dependent on how well you bill and code, this application is worth tens of thousands of dollars a year to your bottom line. There is no guessing about what to bill. If you know what to bill, it will help you make sure you are compliant. If you have no idea what you're doing, it will tell you. I have taken the liberty of grabbing some screen shots of the application from my iPhone.

As you can see, they keep it simple. They give you options. If you know what you're doing and just need a little nudge, they'll help you decide the right code to submit. If you have no idea what you are doing, they'll do the work for you. You just plug in what you've done.

Since I know most of the rules necessary to bill the various hospital admission and follow up codes, I found most of the application unnecessary for myself. But I can understand why a novice would lean heavily on the history and physical component requirements. The area I found most helpful was deciding whether my patient met a medium or high level of risk, an important and highly underused component of medical decision making. I found myself appropriately capturing a higher level of service by using the risk tables available at the bedside in this E&M iPhone coding application.

On numerous occasions I found myself under billing my patients because I could never remember exactly what constituted a high risk medical process. Is the physician prescribing intravenous lasix or digoxin? Is the patient getting a transfusion of any blood product? Does the patient have peritonitis or alcohol withdrawal? Are they involved in a rule out diagnostic work up? All of these processes will get you a high level risk component of your medical decision making process.

In less than a week, I have billed at least 10 patients at a level three hospital follow up that I otherwise would not have done so based entirely on the bedside reminders placed in this iPhone E&M coding application. Imagine if you were able to appropriately account for just seven patients a week for 26 weeks. That's one patient encounter per day. If you work 30 weeks a year as a hospitalist, and can generate at least $20 additional revenue by appropriately capturing the risk involved in caring for your patients, you've just given yourself a $4,000 raise by doing nothing more than billing out what you should have been billing in the first place. I had another talk with another doc the other day about how they decide what they are billing for the day. They base it on a feeling they have about what the level of the visit feels like.

Quit feeling and start doing. If you have an iPhone, spend $20 to quit feeling and starting doing. Consider this one of my many in a string of efforts to help physicians stop screwing themselves out of tens of thousands of dollars a year that they have rightfully earned by the rules they must practice under. For those who prefer old school, here is a copy of my bedside coding card.